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STATE OF MINNESOTA <br />Department of <br />Administration <br />Our mission: <br />To improve the quality <br />and productivity <br />of Minnesota <br />government. <br />Exhibit A <br />OPTION NOTICE <br />SPECIFIC PROJECT FORM <br />PLAN REVIEW AND /OR INSPECTIONS OPTION <br />DATE: D <br />[ <br />[ <br />PROJECT: DS1 <br />LOCATION: DS2 <br />COUNTY: CNTY <br />******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** <br />* State Assigned Project Number: C <br />******** * * * * * ** * * * * * * * * * * * * * * ** * * * * * * ** <br />The State of Minnesota, Department of Administration, Building Codes and Standards Division <br />(hereinafter "BCSD ") and MCDNAME (hereinafter "Municipality") have executed <br />a Contract dated CD (hereinafter "Contract ") conferring upon Municipality responsibility <br />for administration of the State Building Code, Minnesota Statute SS16B.59 to 1613.75 and <br />Minnesota Rules Chapters 1300 - 1370 (hereinafter "Code ") for state licensed facilities within <br />the Municipality's jurisdiction. <br />The Contract provides that Municipality may, at it's option, choose the projects for which it <br />wishes to provide services by indicating that choice on this project form and by returning this <br />form within 15 days to: Building Codes and Standards Division <br />408 Metro Square 7th and Robert Street <br />St. Paul, MN 55101 <br />By initialing (a) or (b) below, Municipality exercises it's option under Paragraph 2 of the <br />Contract to administer the Code. <br />(a) For this project, Municipality agrees to do Plan Review and Inspections as <br />defined in the Contract, Paragraph 3, Subdivision a. <br />(b) For this project, Municipality agrees to do inspections only, as defined in the <br />Contract, Paragraph 3, Subdivision b. <br />This project form constitutes notice to the State that the Municipality hereby exercises its <br />option. <br />APPROVED APPROVED <br />Authorized Municipal Official Date State Building Official Date <br />Building Codes and Standards Division, Facilities Management Bureau, 408 Metro Square Building, <br />Seventh and Robert Streets, St. Paul, MN 55101; Voice: 612 2964639; Fax: 612 297 -1973 <br />TTY/TDD: Twin Cities 612 297 -5353 or Greater Minnesota 800 657 -3529 and ask for voice number <br />Page 22 <br />